These are easy to read and understand and are beautifully presented.
I've had several people ask me what my alternatives to castor oil induction
were since I had said it wasn't my favorite way....so here goes:
First of all, I seldom induce labor. I find that induced labors are
harder, whether you use castor oil, pitocin, ROM, etc. If the body isn't
ready to go into labor on its own, then forcing it to go into labor is
not going to be easy. I find it very hypocritical for a midwife to slam
doctors for inducing labor with pitocin and ROM, which is usually painful
but fast and then turn around and induce labor using ineffective methods
like castor oil which are still painful but SLOW!!!
Reasons I don't like castor oil:
It's awful to get down. Most moms gag and/or vomit.
It's awful to get out. Having a red, burning butthole is not what I would
want to deal with while trying to deliver a baby.
It's hard to control where the contaminated oil and loose feces coming
from the anus goes during labor and while the baby is being born. I feel
this is a very vital problem if there is PROM. I NEVER suggest castor oil
if there is any question of ROM.
If it doesn't work, the mother still has to go through hours of serious
cramping and discomfort. I always worry that if after the poor mom has
gone through the whole day with cramps, contractions and sitting on the
toilet, when she finally does go into labor and she is now too exhausted
and wiped out to handle labor well.
If it doesn't work (and it frequently doesn't) the dad has taken a day
off work and is a little upset about that and mentally the mom feels like
a failure. She now feels like not only couldn't she get into labor on her
own, but now she can't even do it with help.
As a midwife I dislike the extra time and energy that inducing takes. A
doctor or hospital midwife (I know there are midwives who don't practice
this way so please no hate mail!) can leave the induction and waiting to
the hospital nurses, but OOH midwives need to be in very close contact
with someone who is taking castor oil. I've seen castor oil start labor
within a few hours and I've also seen it take over 24 hours and during
that 24 hours the mom is miserable and needs a lot of attention. She is
nervous, can't tell the difference between labor and cramping, and is afraid
you won't make it because she won't be able to tell when it's real labor......so
the midwife ends up going back and forth a few times to check her and reassure
her. By the time the mother needs normal labor help the midwife and all
the support people are exhausted.
I guess that some of the reasons I don't like castor oil are the same reasons
I don't like inducing. I know that there are many of you who have to get
women into labor because of license restrictions and you have no control
over that. I have no restrictions and therefore have a little more leeway
with waiting a little longer for labor to start on its own. When I do think
that inducing is indicated or I simply can't talk the mother out of it,
here are my preferences; I seldom use only one of these...... if I am serious
about getting a baby out, I mean business and will suggest the mom do multiple
I prefer that all inductions start early in the morning and stopped
at bedtime...even if the mom has to take a bath or a glass of wine.
Stripping the membranes. I will do this more than once if needed.
Golden seal tincture and Matrigin. I have the mother take these alternately
every 15 minutes for an hour and then every 30-60 minutes until labor is
well established or bedtime. I have used Matrigin vaginally also with some
Nipple stimulation. I prefer that the women use an artificial means of
stimulation such as a breast pump. Doing it to yourself or having your
husband do it, just doesn't work as well.
If no sign of ROM, castor oil.
ROM. I only use this if the woman has had a previous normal labor and vaginal
birth, and she is at least 4 cm dilated and desperate!!! I've only done
this three times...twice on the same woman who had been 6-7 cm. for over
a week and one woman who was 5 cm. and who felt she would only go into
labor if I AROM’ed her like her doctor had always done at that point....she
had the baby a couple of hours later!
In the last eight months I have only had two women who "needed" to be induced,
one had ROM of a few days. A Mexican doctor friend had given me a few tablets
of cytotec and I tried it (with full informed consent) on these women and
it worked beautifully. It is probably illegal for me to carry any drugs
(I've never used pitocin on anyone and have just recently even had it in
my possession) so whether I will continue to use cytotec for inductions
will depend on many things.